Medically Indicated Late-Preterm and Early-Term Deliveries American College of Obstetricians and Gynecologists Committee Opinion #560
Late preterm and early-term births are warranted in a number of maternal, fetal, and placental complications. Physicians must balance the maternal and newborn risks with the risks of further continuation of pregnancy. Delivery decisions must be individualized.
- The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have long discouraged nonindicated delivery before 39 weeks of gestation.
- Neonatal risks of late preterm (34 0/7–36 6/7 weeks of gestation) and early-term (37 0/7–38 6/7 weeks of gestation) births are well established.
- Maternal, fetal, and placental complications (Table) in which either a late-preterm or early-term delivery is warranted. The timing of delivery in such cases must balance the maternal and newborn risks of late-preterm and early-term delivery with the risks of further continuation of pregnancy.
- Decisions regarding timing of delivery must be individualized.
- Amniocentesis for the determination of fetal lung maturity in well-dated pregnancies generally should not be used to guide the timing of delivery.
o First, if there is a clear indication for a late-preterm or early-term delivery for either maternal or newborn benefit then delivery should occur regardless of such maturity testing. Conversely, if delivery could be safely delayed in the context of an immature lung profile result then no clear indication for a late-preterm or early-term delivery actually exists.
o Second, mature amniotic fluid indices are not necessarily reflective of maturity in organ systems other than the lungs.